2021 preliminary budget - snohd.org

2021PreliminaryBUDGET

Resilience.Recovery.

Partnerships.

PublishedNovember 2020

Snohomish Health District 2021 Preliminary Budget

BOARD OF HEALTH MEMBERS

• Stephanie Wright, Chair, Snohomish County Councilmember *• Kyoko Matsumoto Wright, Vice Chair, Mayor of Mountlake Terrace• Scott Bader, Everett City Councilmember• Elisabeth Crawford, Mukilteo City Councilmember• Megan Dunn, Snohomish County Councilmember *• Adrienne Fraley-Monillas, Edmonds City Councilmember *• Christine Frizzell, Lynnwood City Councilmember• John Joplin, Brier City Councilmember• Anji Jorstad, Lake Stevens City Councilmember• Sam Low, Snohomish County Councilmember• Jared Mead, Snohomish County Councilmember• Nate Nehring, Snohomish County Councilmember• Dan Rankin, Mayor of Darrington • Linda Redmon, Snohomish City Councilmember *• Jeff Vaughan, Marysville City Councilmember

* Budget Ad Hoc Committee

HEALTH DISTRICT SUPPORT

• Shawn Frederick, Administrative Officer• Pam Aguilar, Human Resources Manager• Linda Carl, Executive Assistant• Katie Curtis, Prevention Services Director• Ragina Gray, Environmental Health Director• Sarah de Jong, Administrative Assistant• Tracey Kellogg, Finance Manager• Lynn Ljungquist, Graphic Designer• Rich Son, Accountant• Bruce Straughn, Environmental Health Assistant Director• Heather Thomas, Public & Government Affairs Manager

Acknowledgements


HONORABLE BOARD OF HEALTH MEMBERS:

It is my pleasure to submit to you my budget for 2021.

We entered 2020 with a balanced budget, and plans for a more sustainable organization. Few people could have predicted the challenges we all faced this year. Every corner of Snohomish County has been impacted, and we’ve all had to rethink, retool, and regroup.

I hope you join me in the immense pride I have for the hard-working staff at the Snohomish Health District as they have risen to challenge after challenge. Thrust into the national and global spotlight with the first confirmed case of COVID-19 in the United States back in January, and are still working with the same determination and passion for protecting the people of Snohomish County all these months later.

Even with a pandemic, public health’s work doesn’t stop. Here are some of the accomplishments that achieved in spite of the significant strain of COVID-10 on our agency.

Administrative Services: The division remains steadfast in securing the resources needed for Prevention Services and Environmental Health to conduct their vital work.

• In April 2020, the Finance program implemented remote deposit capture, where checks for deposit are scanned into the District’s bank account onsite, replacing the need for daily deposits to be delivered to the bank’s night drop. This reduced bank charges for deposits by approximately 50% or $200 per month, as well as reduced deposit preparation steps for Finance & Customer Service staff. The District now receives same day credit for the deposit, instead of a one day lag.

• Human Resources worked towards implementing online performance management/performance reviews, which should be up and running for 2021. They also used Microsoft Teams to streamline interviewing, hiring, and onboarding of 70+ CARES Act funded temporary staff, and pivoted to a 100% remote open-enrollment process.

• The HVAC system at the Rucker Building was renovated over the summer, including installation of new units on the roof of the building.

• The Communications team had a 435% increase in traffic to www.snohd.org, and a reach of more than six million through all social media channels.

• A policy and procedures framework was adopted by the Board of Health, along with the creation and updates of several policies needed to improve structure and clarity.

• Staff worked with the ad hoc committee to vet feasibility of a public health foundation, and supported the selection of the seven founding board members for the Sound Foundation for Public Health.

Environmental Health: The Environmental Health division helps ensure the food, water, and environment of Snohomish County are safe from health threats such as disease, pollution, pests, and other hazards. While many of our activities were interrupted by restrictions put in place for COVID-19, staff engaged significantly in other areas related to the pandemic response, such as providing guidance and education to business owners, food establishments, farmers markets, agritourism, schools, and governments on safe reopening and compliance with Safe Start guidelines. The division welcomed a new Director in March of 2020, and also welcomed a few new faces to the Food Safety Program. Also, Vital Records and the Environmental Health Support Staff officially joined the Environmental Health team.

Introduction

http://www.snohd.org


Introduction

District staff have made several notable accomplishments and participated in multiple partnerships across the region, among them:

• Completed more than 4,500 inspections per year at restaurants, grocery stores, food booths, and other establishments. In 2020, this work was made even more vital as food establishments, including farmers markets, were deemed essential services. Like so many other industries, our Food Team had to use innovation and creativity to ensure food establishments remained open and safe for the public, while keeping staff safe and healthy during inspection activities.

• Reviewing over 1,000 on site septic permit applications annually as well as nearly 1,500 building permits and land use proposals for compliance with Health District code requirements.

• Increasing outreach to businesses about safe disposal of hazardous waste, including through technical assistance visits, handouts, and online resources.

• Partnered with several organizations and government agencies as part of the Phase 3 Stillaguamish Pollution Identification and Correction program. In 2021, these efforts will focus on Onsite Sewage monitoring and maintenance in areas of the Stillaguamish watershed and South Skagit Bay experiencing high levels of contaminants associated with septic systems.

Prevention Services: The Prevention Services Division is responsible for investigating communicable diseases, providing linkages to care for parents and children, responding to emergencies, and examining data to help staff and community partners make the best decisions for the residents of Snohomish County. As laid out in the 2020 budget, the Healthy Communities and Assessment teams have been integrated within Prevention Services. While Public Health Emergency Preparedness & Response (PHEPR) was intended to move within Environmental Health, the COVID-19 pandemic highlighted the better fit within this division instead. Some of the work accomplished in the Division include:

• Responding to the global COVID-19 pandemic. The agency ramped up to meet the needs of case investigation, contact tracing and testing.

• Treated 36 active TB patients, provided screening to 30 suspected cases. Treated 49 patients/contacts who had Latent Tuberculosis Infection (thus preventing further active cases). Provided medical screening to 155 new arrival refugees.

• As of September 30, MRC has activated 222 unique volunteers to provide 16,229 volunteer hours on this response.

• Engaged community partners to create a school vaccine safety net for uninsured families in 67 schools and 4 school districts.

• Created an Opioid Prevention Consortium for rural east county including 16 partners (completing a county gaps analysis, work plan, staffing plan, sustainability plan and securing 3 more years of implementation funding).

• Through our pharmacy program we distributed 97 medication lock boxes and bags, accompanied by information about prevention and safe storage of medications (intended for those filling opioid prescriptions).

• Since SHD took over Naloxone distribution for law enforcement on Feb 7th we have distributed 1196 doses (and officers have deployed 67 doses).

• Since Jan. 1, 2020, five snapchat anti-vape posts received 197,949 paid impressions, with 2,902 swipe-ups (to access more info/web links).

• Facebook/Instagram anti-vape posts reached 28,704, with 2,407 engagements (clicking for more info/links, sharing, etc.)

• Served 286 children who have serious physical, behavioral or emotional conditions that require health and related services beyond those required by children generally with 1,115 services including 95 home visits, 216 telehealth services and 514 follow-up calls.


Introduction

• Trained 1,234 Childcare Providers who completed 2,808 SHD health & safety courses as an upstream promotion strategy of healthy early childhood development.

• Residents reached 522 times with information on dental health.• 529 immunizations providers trained or given technical assistance on various Vaccines & Preventable

Disease topics.• Followed up with 118 families with babies whose mothers have Hepatitis B to protect the babies from

contracting the virus. • Began offering court ordered HIV testing at the Edmonds Community Court• In 2019 our STD program investigated 2835 cases of chlamydia, 764 cases of Gonorrhea, and 151 cases of

syphilis

Yet, even with this dedicated team, it has again highlighted how precarious the public health system is locally, statewide, and nationally. Had it not been for emergency allocations from the state legislature and federal CARES Act money through Snohomish County, the Snohomish Health District would not have had the capacity to maintain this sustained and complex response. We are actively engaging with the federal delegation along with local partners to ensure these dollars are both extended past the December 2020 deadline, and expanded to continue supporting critical response efforts.

This budget does not include COVID-19 response activities based on what they look like today. Once we receive confirmation of CARES Act extension, as well as any new dollars, we will come back to the Board for a budget amendment.

Respectfully,

_________________________Shawn Frederick, MBAAdministrative Officer


Tab

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tsAcknowledgements ............................................................................2

Introduction .........................................................................................3

About Snohomish Health District ........................................................7

Vision, Mission & Values ....................................................................8

Budget Overview ................................................................................9 Chart Indicating Budget Forecast with Fee Increases and Staff Reductions ....................................................................9 Organizational Charts ...................................................................11 Assumptions Used in Creation of the Projection ..........................12

Revenues ...........................................................................................14 Chart Indicating Sources of Revenue ...........................................14 Chart with Revenue Over Previous Years to Include Budget ..........................................................................................15

Expenditures.......................................................................................17 Simple Chart Labor vs. Non-Labor ...............................................17 Chart Showing Expenditures Over Previous Years to Include Budget ..............................................................................17

Division Budgets .................................................................................18 Operating Budget Overview .........................................................18 Administrative Services Division ...................................................19 Environmental Health Division ......................................................21 Prevention Services Division ........................................................24

Capital Request ..................................................................................27

Non-Capital Request ..........................................................................28

Policy Discussions ..............................................................................29

Appendices .........................................................................................30 To be added in final budget document

Table of Contents


The Snohomish Health District’s mission is to spearhead efforts to protect, promote and advance the collective health of our community. It will continue to do this by focusing on activities that are grounded in a set of foundational public health services, which include:

• Communicable Diseases & Notifiable Conditions• Chronic Diseases & Injuries• Environmental Health Maternal, Child & Family Health• Vital Records • Ongoing, Critical Public Health Issues• Access to Medical, Dental & Mental Health Care• Building a Sustainable Organization

In Washington State, responsibility for public health protection is shared among the State Board of Health, Washington State Department of Health, and the 35 local health jurisdictions covering the 39 counties. Responsibility for governance of local public health boards is placed solely with counties.

The Snohomish Health District was created in 1959 as an independent special-purpose district responsible for public health in Snohomish County. We’re separate from Snohomish County government, although it provides financial support and is an essential partner in many functions.

A 15-member Board of Health oversees all matters pertaining to the preservation of life and the health of the population, including policy and budget development. All five Snohomish County council members sit on the Board of Health, together with 10 city council members or mayors representing the cities and towns. Public meetings of the Board of Health are held monthly.

State law also requires each local board of health to appoint a licensed, experienced physician as the local health officer. Chris Spitters, MD, MPH, serves as the Health Officer for the Snohomish Health District. Shawn Frederick, MBA, serves as the Administrative Officer.

About The Snohomish Health District


The new 2020 Strategic Plan incorporated a new vision, mission and value statements as approved by the Board of Health.

Vision StatementBy leading and partnering with our communities we create a resilient and healthy community throughout Snohomish County.

Mission StatementThe Snohomish Health District spearheads efforts to protect, promote, and advance the collective health of our community.

ValuesCommitment to our community:Dedicated to those we serve and pursuing the common good. We engage our community and partners to help solve problems, share new ideas, and explore perspectives. Holding a very inclusive and broad view of the entire community and its needs, we focus our collective energy on producing positive benefits.

Advancing clear, open and honest communication:Prioritizing good communication with the Board of Health and the community is fundamental to the effective operation of the District. This includes speaking openly, practicing active listening and prioritizing timely internal and external communications, not only ad hoc, but also through formalized processes and channels. An environment that strives to be free of surprises, helps build trust and fosters teamwork across the organizationand with the community.

Responsible use of resourcesWe are deliberate stewards of the public resources with which we are entrusted. We commit to employing evidence-based strategies, careful deliberation and transparency of decisions. We demonstrate integrity through smart spending of time and money and establishing measurable and attainable expectations.

Driven by diversity, equity and inclusionWe are open to different opinions and ideas, inclusive of everyone, and committed to understanding the inequitiesthat are barriers to healthy lives and living. We adapt to changes in the community, its composition and demographics, its needs and concerns, and strive to provide services equitably. The organization celebrates andrespects the uniqueness of cultures, communities and diverse ideas, and strives to reflect the community’s demographics.

Operating as a teamThe District works as a team and is accountable to each other in improving the health of the community (achieving our goals) by taking pride and ownership in our work, meeting our agreed timelines and celebrating our successes. We trust and respect each other and can acknowledge our mistakes, and we individually and collectively strive to deliver quality services.

Vision, Mission & Values


The Health District has been in the midst of transformation over the last several years. We have embarked on a series of efforts to examine and align strategies, evaluate programs and services in the context of foundational public health, and keep pace with the reformation of the healthcare system. It’s both exciting and challenging, but still necessary work to ensure the District can provide sustainable services into the future.

Budget Overview

Admin Services

Environmental Health

Prevention Services

Total %

Revenue:Licenses & Permits $0 $4,314,297 $0 $4,314,297 27.19%Federal Grants 0 0 2,591,967 2,591,967 16.34%State Grants 2,918,298 391,619 685,668 3,995,585 25.18%Intergovernmental Revenue 1,066,380 43,000 1,500,000 2,609,380 16.45%Charges for Goods & Services 204,132 1,707,370 327,961 2,239,463 14.12%Miscellaneous Revenues 114,557 0 0 114,557 0.72% Total Revenues before Reorganization 4,303,367 6,456,286 5,105,596 15,865,249 100.00%

Expenditures (Before OH Allocations)Labor:Salaries & Benefits ($2,396,294) ($4,825,813) ($4,789,472) ($12,011,579) 75.71%

Non-Labor:Supplies ($36,500) ($39,063) ($153,672) ($229,235) 1.44%Professional Services (984,261) (90,310) (352,396) (1,426,967) 8.99%Communication (83,876) (27,480) (30,777) (142,133) 0.90%Mileage & Travel (11,025) (15,840) (12,851) (39,716) 0.25%Board of Health Per Diem (10,380) 0 0 (10,380) 0.07%Advertising (9,660) 0 (15,367) (25,027) 0.16%Rents & Leases (241,030) (13,800) (12,124) (266,954) 1.68%General Insurance (180,009) 0 0 (180,009) 1.13%Utilities (75,540) 0 0 (75,540) 0.48%Repairs & Maintenance (549,951) (30,690) (16,800) (597,441) 3.77%Other Miscellaneous (70,718) (900) (13,390) (85,008) 0.54%Dues & Memberships (43,565) (3,956) (950) (48,471) 0.31%Subscriptions (3,852) (450) (840) (5,142) 0.03%Printing & Binding (1,660) (11,764) (1,264) (14,688) 0.09%Tuition & Registration (10,660) (11,960) (16,540) (39,160) 0.25%Software Licences & Support (213,853) (145,948) (232,498) (592,299) 3.73%Software Licences & Support - Board (5,500) 0 0 (5,500) 0.03%Capital (70,000) 0 0 (70,000) 0.44%Subtotal - Non-Labor ($2,602,040) ($392,161) ($859,469) ($3,853,670) 24.29% Total Expenditures before Reorganization ($4,998,334) ($5,217,974) ($5,648,941) ($15,865,249) 100.00%

Net Revenue ($694,967) $1,238,312 ($543,345) $0

2021 PRELIMINARY BUDGET


This budget includes the following assumptions:

• Adding 2.0 FTE (1.0 FTE in Environmental Health for the Onsite Monitoring and Maintenance program, 0.5 FTE for an accountant, and 0.5 FTE for a grants coordinator).

• A preliminary increase of 5.0% for 2021 medical and dental rates through Public Employee Benefits Board.• No increase in 2021 vision rates through Washington Counties Insurance Fund.• PERS employer rated increased from 12.86% to 12.97% as of September 2020. The Washington State

Actuary is currently projecting rates to fall to 10.25% as of July 1, 2021. This budget averages the two rates for an 11.61% PERS rate for 2021.

• Interest rates have declined significantly since April 2020, and a 35% decrease in interest income is reflected in the 2021 budget.

The agency’s organizational chart, omitting current COVID-19 activities, is shown on the next page.

Budget Overview

125.9

113.0 107.6

0.0

20.0

40.0

60.0

80.0

100.0

120.0

140.0

2019 Approved Budget 2020 Approved Budget 2021 Preliminary Budget

Budgeted Full Time Equivalents


9/4/2019 pea

ADMINISTRATION TITLE FTE

Privacy and Public Records Officer 1.0

Business Management Analyst 1.0 Administrative Assistant 1.0

Program Specialist II .90

FINANCE OFFICE Finance Manager 1.0 Program Specialist II 1.0

Accountant 1.0 Purchasing Coordinator .50

Payroll Analyst 1.0 HUMAN RESOURCES Human Resources Manager 1.0 Human Resources Assistant 1.0

MAINTENANCE/FLEET Building & Fleet Maintenance Specialist 1.0 COMMUNICATIONS & POLICY Public & Government Affairs Manager 1.0 Communications Coordinator 1.0

Graphics Designer 1.0 Policy Analyst 1.0

ENVIRONMENTAL HEALTH Environmental Health Director 1.0

Environmental Health Assistant Director 1.0 TITLE FTE

Administrative Supervisor 1.0 Program Specialist II 1.0 Program Assistant I 3.0 Program Assistant II 5.0 SAFE ENVIRONMENTS & LAND USE Environmental Health Supervisor 2.0 Environmental Health Specialist III 2.0 Environmental Health Specialist I/II 13.0 FOOD SAFETY Environmental Health Supervisor 2.0 Environmental Health Specialist III 2.0 Environmental Health Specialist I/II 11.0 Health Education Delivery Specialist .20 Health Educator .50

PREVENTION SERVICES Prevention Services Director 1.0 FTE

Prevention Services Assistant Director 1.0 FTE TITLE FTE TITLE FTE

ASSESSMENT MATERNAL CHILD HEALTH/FIRST STEPS, VACCINE PREVENTABLE DISEASE Epidemiologist II 3.0

HIV/STDs, VHO, CD SURVEILLANCE & RESPONSE MCH Supervisor 1.0 Public Health Nurse 6.0 Communicable Disease Supervisor 1.0

Lead Disease Intervention Specialist 1.0 Vaccine Coordinator 1.0 Disease Intervention Specialist STD/HIV 3.0 Environmental Health Specialist I/II .50 Disease Intervention Specialist VHO 1.0 Registered Dietician .50 Public Health Nurse 3.0 Behavioral Health Specialist .50 Disease Intervention Specialist TB/STD/HIV 1.0 Program Assistant II 1.0 TUBERCULOSIS & REFUGEE HEALTH TB & Refugee Supervisor 1.0 Outreach & Preparedness Supervisor 1.0 Registered Nurse 1.9 Healthy Community Specialist 4.6 Outreach Worker II 2.0 Health Educator 1.0 Public Health Nurse 3.0 Emergency Management Specialist 3.0 Program Specialist II 1.0 Program Assistant II 1.0

BOARD OF HEALTH

ADMINISTRATIVE OFFICER 1.0 FTE

EXECUTIVE ASSISTANT 1.0 FTE

HEALTH OFFICER 1.0 FTE


The following chart incorporates expenditure assumptions discussed previously as well as the expected effect of Environmental Health fee increases recently approved.

Budget Overview

2017 Actual 2018 Actual 2019 Actual2020

ApprovedBudget

2020Amended

Budget

2021Preliminary

Budget

2022Projected

2023Projected

2024Projected

2025Projected

2026Projected

2027Projected

Non-Labor 2,805,992 3,059,261 3,706,629 3,686,362 6,717,921 3,853,670 4,136,915 4,328,867 4,534,928 4,868,245 5,226,061 5,610,176Labor 13,505,860 14,031,963 13,272,035 13,067,643 20,042,980 12,011,579 12,133,806 12,395,421 12,662,813 12,929,876 13,202,732 13,481,513Revenue 16,448,303 17,474,124 16,403,171 16,754,005 28,668,602 15,865,249 16,127,734 16,232,442 16,533,805 16,845,104 17,166,762 17,499,222

0

2,500,000

5,000,000

7,500,000

10,000,000

12,500,000

15,000,000

17,500,000

20,000,000

22,500,000

25,000,000

27,500,000

30,000,000

32,500,000

Budget Projection, 2022 - 2027

Labor Non-Labor Revenue


Projected revenues through 2027 are insufficient to cover projected expenditure increases, the bulk of which are due to an ongoing rise in labor costs. While 2021 through 2025 are fairly stable, current trends would leave the District with an inadequate total fund balance to cover reserves starting in 2026. Securing new and sustainable funding sources is critical to the agency’s long term financial stability. This includes revenues anticipated from the new public health foundation, as well as rental of unused space in the Rucker Building.

Budget Overview

0

5,000,000

10,000,000

15,000,000

20,000,000

25,000,000

30,000,000

35,000,000

2019 Actuals 2020 Approved 2020 AmendedBudget

2021Preliminary

Budget

2022 Projected 2023 Projected 2024 Projected 2025 Projected 2026 Projected 2027 Projected

Fund Balance Projection 2020 - 2027

Revenues Expenditures Unassigned Fund Balance & Reserves Reserves


Revenues

The agency relies heavily on roughly 60 percent of its funding coming from intergovernmental revenue (federal, state, county and city sources) to support public health services. More than two-thirds of the District’s revenue is “restricted” or “categorical,” which means the majority of the agency’s funds can only be used for specific purposes.

Licenses & Permits

27.2%

Charges for Goods & Services14.1%

Miscellaneous Revenues

0.7%

Federal Grants16.3%

State Grants25.2%

County Grant0.3%

County Per Capita4.6%

County TB & Communicable

Disease Funding9.5%

City Per Capita2.1%

Intergovernmental58.0%

2021 Budgeted Revenue By Source


In addition to intergovernmental funds remaining static or declining, these funds are limited term, unpredictable, or fluctuating grants that limit the District’s ability to institute change. Grant funding, in particular, does not provide the District with the flexibility needed to begin delivering public health services through broader, more community-based mechanisms. The chart below depicts the District’s revenue by source for a five-year period.

The 2020 Amended Budget reflects the influx of CARES Act and other COVID-19 funding. Most of that funding is currently set to expire in December 2020. While we anticipate receiving an extension and additional dollars in 2021, nothing has been confirmed so this budget does not include those projections.

District-generated revenues (licenses and permits; charges for services), along with Snohomish County funding and city per capita contributions, compose “local revenue.”

Snohomish County and City Funding As funding levels have been continuing to decrease and without the ability to levy taxes, the District requested a per capita contribution from the cities, towns, and county starting in 2017. These direct investments in public health by local cities, towns, and Snohomish County have been critical. The chart to the right reflects annual per capita contributions since 2017.

Revenues

0

2,000,000

4,000,000

6,000,000

8,000,000

10,000,000

12,000,000

14,000,000

16,000,000

18,000,000

20,000,000

22,000,000

24,000,000

26,000,000

28,000,000

30,000,000

2017 Actual 2018 Actual 2019 Actuals 2020 ApprovedBudget

2020 AmendedBudget

2021 Budget

Revenue History by Source

Licenses & Permits Intergovernmental Revenue Charges for Goods & Services Miscellaneous Revenues

$0

$200,000

$400,000

$600,000

$800,000

$1,000,000

$1,200,000

2017 Actual 2018 Actual 2019 Actual 2020ApprovedBudget

2020AmendedBudget

2021Preliminary

Budget

Year-to-Year Per Capita Comparison

Cities County


Revenues

The District has made a request for all cities and the county to provide a per capita contribution for public health funding again in 2021. As many city budgets are not confirmed as of the report date, the budget conservatively includes $1,066,380 which represents a 10% reduction in most city per capita contributions. The table below represents city and county per capita contributions anticipated as of November 4, 2020.

Licenses and Permits Our Environmental Health division collects license and permit fees from food vendors, public and semi-public swimming pools, on site septic systems, small public water systems, and solid waste disposal facilities. Fees cover the costs of administration and inspections to ensure safe and sanitary operations. This budget includes a fee increase as approved by the Board of Health, effective November 1, 2020.

Charges for Services The District charges clients for some Communicable Disease-related services, including refugee health, vaccine- preventable disease, and tuberculosis monitoring services. Environmental Health charges include public/private water supplies, solid waste, liquid waste, and food safety program activities. The District also provides services related to solid and hazardous waste management to Snohomish County via a fee-for-services interlocal agreement. Tasks include monitoring and inspecting county and non-county facilities, responding to complaints and taking enforcement actions, educating and coordinating prevention activities, and providing performance reports on such activities.

Miscellaneous Revenue The District has leased a part of the Rucker Building to the General Services Administration on behalf of the Internal Revenue Service. The current lease expires November 30, 2022. The District also receives interest on investments made through the Snohomish County Treasurer’s Office, and non-governmental grants through the North Sound Accountable Communities of Health and the Kresge Foundation.

Jurisdiction2020

Population12021 Per

Capita Rate2020

Contribution2

2021 Preliminary

BudgetNotes

Snohomish County 369,400 $ 1.97 $751,618 $726,618 In Exec's budgetArlington 20,600 $ 1.00 0 Still deliberatingBothell3 18,670 $ 1.18 22,000 22,000 For 21-22 bienniumBrier 6,760 $ - 0 Still deliberatingDarrington 1,420 $ 1.00 1,410 1,269 In prelim budgetEdmonds 42,470 $ 0.50 42,170 21,085 Tent. $0.50Everett 112,700 $ 1.00 111,800 100,620 In Mayor's budgetGold Bar 2,195 $ - 0 Not available yetGranite Falls 4,425 $ 1.00 4,307 3,876 In prelim budgetIndex 175 $ - 0 Not available yetLake Stevens 34,150 $ 1.01 33,080 34,500 In prelim budgetLynnwood 40,690 $ 1.00 39,600 35,640 In prelim budgetMarysville 69,180 $ - 67,820 61,038 Still deliberatingMill Creek 20,590 $ - 0 Released 11/3Monroe 19,800 $ - 0 Not in Mayor's budgetMountlake Terrace 21,660 $ 1.02 21,560 19,404 In prelim budgetMukilteo 21,360 $ 1.01 21,478 19,330 In prelim budgetSnohomish 10,240 $ 2.05 19,250 21,000 In prelim budgetStanwood 7,125 $ 0.98 7,020 In prelim budgetSultan 5,530 $ - 0 Not in budgetWoodway 1,360 $ - 1,350 In prelim budgetTotal 830,500 1,144,463 1,066,380

1. Data from www.ofm.wa.gov/pop/april1/poptrends.pdf

2. Per 2020 ILAs

3. Population of Snohomish County portion only


As a public service agency delivering services to clients, customers, and county residents, the majority of expenses the District incurs are personnel-related costs. The second largest expenditure type is Other Services and Charges, which includes costs associated with professional services and contracts (i.e., insurance, legal services, telephone and network systems, and utilities). Breakdowns of expenditures by type are shown in the charts below.

Expenditures

0

5,000,000

10,000,000

15,000,000

20,000,000

25,000,000

30,000,000

2017 Actual 2018 Actual 2019 Actuals 2020 ApprovedBudget

2020 AmendedBudget

2021 Budget

Expenditure History by Type

Labor Supplies Other Services & Charges Capital Outlay

Labor75.7%

Supplies1.4%

Other Services & Charges22.4%

Capital1.5%

2021 Budgeted Expenditures by Type


The table below provides an overview of revenues and expenditures by division. Additional details by division are included in the following pages.

OPERATING BUDGET OVERVIEW

Division Budgets

Admin Services


Prevention Services

Total %

Revenue:Licenses & Permits $0 $4,314,297 $0 $4,314,297 27.19%Federal Grants 0 0 2,591,967 2,591,967 16.34%State Grants 2,918,298 391,619 685,668 3,995,585 25.18%Intergovernmental Revenue 1,066,380 43,000 1,500,000 2,609,380 16.45%Charges for Goods & Services 204,132 1,707,370 327,961 2,239,463 14.12%Miscellaneous Revenues 114,557 0 0 114,557 0.72% Total Revenues before Reorganization 4,303,367 6,456,286 5,105,596 15,865,249 100.00%

Expenditures (Before OH Allocations)Labor:Salaries & Benefits ($2,396,294) ($4,825,813) ($4,789,472) ($12,011,579) 75.71%

Non-Labor:Supplies ($36,500) ($39,063) ($153,672) ($229,235) 1.44%Professional Services (984,261) (90,310) (352,396) (1,426,967) 8.99%Communication (83,876) (27,480) (30,777) (142,133) 0.90%Mileage & Travel (11,025) (15,840) (12,851) (39,716) 0.25%Board of Health Per Diem (10,380) 0 0 (10,380) 0.07%Advertising (9,660) 0 (15,367) (25,027) 0.16%Rents & Leases (241,030) (13,800) (12,124) (266,954) 1.68%General Insurance (180,009) 0 0 (180,009) 1.13%Utilities (75,540) 0 0 (75,540) 0.48%Repairs & Maintenance (549,951) (30,690) (16,800) (597,441) 3.77%Other Miscellaneous (70,718) (900) (13,390) (85,008) 0.54%Dues & Memberships (43,565) (3,956) (950) (48,471) 0.31%Subscriptions (3,852) (450) (840) (5,142) 0.03%Printing & Binding (1,660) (11,764) (1,264) (14,688) 0.09%Tuition & Registration (10,660) (11,960) (16,540) (39,160) 0.25%Software Licences & Support (213,853) (145,948) (232,498) (592,299) 3.73%Software Licences & Support - Board (5,500) 0 0 (5,500) 0.03%Capital (70,000) 0 0 (70,000) 0.44%Subtotal - Non-Labor ($2,602,040) ($392,161) ($859,469) ($3,853,670) 24.29% Total Expenditures before Reorganization ($4,998,334) ($5,217,974) ($5,648,941) ($15,865,249) 100.00%

Net Revenue ($694,967) $1,238,312 ($543,345) $0



ADMINISTRATIVE SERVICES DIVISION

The Administrative Services Division includes:

AdministrationAdministration provides overall direction and management for District staff and operations, as well as support activities for the divisions. The health officer and administrative officer translate policy decisions by the Board of Health into program direction and operating guidelines for the divisions; provide leadership and management of agency financial, human, and physical resources; engage community partners, government and tribal organizations, and elected officials; and develop, implement, and monitor strategic, and operational plans.

Communications and OutreachThe Communications and policy team supports agency initiatives through development and implementation of plans, strategies, and tools to effectively deliver public health information. The department also manages health- awareness campaigns, social media, website content, community outreach, and media relations. This budget includes a 0.5 FTE grants coordinator to research, write and coordinate the grant application and performance process.

Facilities and Fleet ManagementFleet costs such as fuel and repairs are charged directly to the program where the vehicle is assigned, and depreciation is included in the equipment-depreciation allocation. Staffing costs are allocated based on the number of staff per department.

FinanceFinance supports financial and business needs of the agency, which includes purchasing, accounting, payroll, internal audit services, monthly and annual financial reports, budgeting and financial analysis, and management. This budget includes a 0.5 FTE accountant to improve internal processes and implement an internal audit function that current staffing cannot achieve.

Human ResourcesHuman Resources provides agency-wide coordination, assistance, and guidance on employee management. The department administers federal, state, and agency-wide policies and procedures, Labor Relations Act mediations, labor negotiations, and bargaining agreement administration. The department also provides recruitment and retention initiatives, compensation and benefits administration, and training and professional development.

Division Budgets


ADMINISTRATIVE SERVICES DIVISION

Division Budgets

Admin Services

Revenue:Licenses & Permits $0Federal Grants 0State Grants 2,918,298Intergovernmental Revenue 1,066,380Charges for Goods & Services 204,132Miscellaneous Revenues 114,557 Total Revenues before Reorganization 4,303,367

Expenditures (Before OH Allocations)Labor:Salaries & Benefits ($2,396,294)

Non-Labor:Supplies ($36,500)Professional Services (984,261)Communication (83,876)Mileage & Travel (11,025)Board of Health Per Diem (10,380)Advertising (9,660)Rents & Leases (241,030)General Insurance (180,009)Utilities (75,540)Repairs & Maintenance (549,951)Other Miscellaneous (70,718)Dues & Memberships (43,565)Subscriptions (3,852)Printing & Binding (1,660)Tuition & Registration (10,660)Software Licences & Support (213,853)Software Licences & Support - Board (5,500)Capital (70,000)Subtotal - Non-Labor ($2,602,040) Total Expenditures before Reorganization ($4,998,334)

Net Revenue ($694,967)



ENVIRONMENTAL HEALTH DIVISION

Revenues and expenditures are expected to be mostly flat. Increases in revenues reflect minor fee adjustments adopted October 13, 2020. There is an increase of one FTE proposed for the new Onsite Monitoring and Maintenance program adopted in 2019. The Environmental Health Division includes:

Environmental Health AdministrationThis program tracks expenses related to the Environmental Health director position. It may also include some expenses that are not specific to an individual program (i.e., some legal costs).

Food Safety ProgramThis program includes food safety activities. These activities are primarily plan review and inspections of permanent and temporary retail food establishments. It also includes all related complaint investigation and enforcement activities.

Liquid WasteThis program includes all activities related to the design review, permitting and inspection of on site sewage disposal systems.

Living EnvironmentCamps (primarily summer youth camps) are permitted and inspected under this program. It also is used to track time spent on myriad of other issues for which there is no dedicated Environmental Health program. Examples include indoor air quality, vector-borne diseases, and water quality of rivers and lakes.

Local Source ControlBusinesses that produce hazardous and dangerous waste are provided with technical assistance on the proper handling, disposal, and re-use of the waste products. Activities are funded by a contract with the Washington State Department of Ecology.

Onsite SepticTime spent on repairs of failing septic systems as well as complaint investigation and enforcement activities related to failing septic systems are tracked in this program. It includes some limited funding from the Washington State Department of Health. In 2021, this will include the implementation of a new Washington State Onsite rule, and the addition of a new staff member to develop and manage the Monitoring and Maintenance program.

Private Public Water SuppliesThis program includes activities related to the review and approval of new individual water supplies. Most often, this is associated with development of vacant land where a public water source is not available.

Sanitary Survey and Technical AssistanceThis program performs sanitary surveys of small Group A water systems with 15 to 100 residential connections. It’s a small program with 15 to 20 surveys per year. Technical assistance may also be provided to water system purveyors. Activities are funded by the State Department of Health via consolidated contract. SchoolsPlan review for new or remodeled schools and the periodic inspection of all K-12 schools in Snohomish County are included in this program. The primary funding source is fees based on inspection times.

Division Budgets


Division Budgets

ShellfishShellfish and mussels are harvested, primarily in summer months, to be sent to a Washington State Department of Health laboratory for analysis for toxins. This program is funded by the State Department of Health (consolidated contract).

Smoking in Public PlacesThis program tracks time investigating complaints related to violation of smoking laws in public areas of buildings.

Solid Waste ActivitiesThis program encompasses most activities related to the review, permitting, and inspection of solid waste handling facilities. These facilities include open and closed landfills, solid waste transfer stations, and recycling facilities. The program is funded by permits and a contract with Snohomish County Public Works.

Solid Waste EnforcementEnforcement activities for this program concern improper storage or disposal of solid waste. They can also include enforcement related to permitted facilities. It’s funded by contracts with Snohomish County Public Works and the Washington State Department of Ecology (Local Solid Waste Funding Assistance).

Stillaguamish Pollution Identification and Correction Phase IIIA contract with the Snohomish Conservation District, in partnership with Snohomish County Surface Water Management, Stillaguamish Tribe, Washington Department of Health, Washington Department of Agriculture and others for some limited activities related to the Pollution Identification and Correction Program. This work dovetails with our new Onsite Septic Monitoring and Maintenance program, and involves outreach to landowners in specific sub-basins around proper care of their OSS systems.

Surface Water ManagementA contract for some limited activities related to the Snohomish County Surface Water Management Division’s Pollution Identification and Correction Program. The contract expires March 2020.

Vital RecordsThis program provides birth and certificates for anyone born in Washington State from 1907 to present, while death certificates are available for all deaths occurring in Everett from 1953 and the remainder of Snohomish County from 1960 to present. In January, 2021, Washington State becomes a closed records state, which means that people requesting a vital record will need to show proof of relationship to the person on the record.

Water Recreation FacilitiesThis program includes plan review, permitting, and routine inspection of all public pools and spas. Most are municipal pools and those in health clubs, apartments, and condominiums.

Water Well ConstructionNewly constructed water wells are inspected during the construction process. This program also includes inspection of decommissioned wells. Activities are funded through a contract with the Washington State Department of Ecology.


Division Budgets

ENVIRONMENTAL HEALTH DIVISION


Revenue:Licenses & Permits $4,314,297Federal Grants 0State Grants 391,619Intergovernmental Revenue 43,000Charges for Goods & Services 1,707,370Miscellaneous Revenues 0 Total Revenues before Reorganization 6,456,286


Non-Labor:Supplies ($39,063)Professional Services (90,310)Communication (27,480)Mileage & Travel (15,840)Board of Health Per Diem 0Advertising 0Rents & Leases (13,800)General Insurance 0Utilities 0Repairs & Maintenance (30,690)Other Miscellaneous (900)Dues & Memberships (3,956)Subscriptions (450)Printing & Binding (11,764)Tuition & Registration (11,960)Software Licences & Support (145,948)Software Licences & Support - Board 0Capital 0Subtotal - Non-Labor ($392,161) Total Expenditures before Reorganization ($5,217,974)

Net Revenue $1,238,312



PREVENTION SERVICES DIVISION

The 2021 budget reflects mostly status quo through most of our grants with minor reductions in a few areas. The 2021 budget shows the addition of the Assessment program, Health Communities and Public Health Preparedness and Response into the Division. Staffing remains consistent across all programs.

AssessmentThe public health functions of community assessment, policy development, and assurance of service delivery are essential elements in achieving the objectives of health reform in Washington State (RCW 43.70.520). The program is responsible for providing detailed analysis of existing public health and health-related data and development of projects using scientific methods to capture and analyze data related to emerging issues and communicable disease.

Access to Baby and Childhood Dentistry (ABCD)The ABCD Program connects low-income families with dentists who know how to care for young children, focusing on prevention and avoiding tooth decay, as well as educating parents about how to take good care of their children’s teeth.

Child Care HealthChildcare Health Outreach Program – provides consultation, education and training on a variety of health, safety, and nutrition topics to childcare providers and preschools throughout Snohomish County. They are available to help promote healthy eating and active play in child care and early learning programs. Additionally, they offer on-site visits and consultations, online distance learning, and resources to help prevent illness.

Communicable Disease Surveillance and ResponseThis program is mandated by WAC 247.101. It includes investigation of over 60 diseases and conditions that are reportable to public health, along with work to interrupt disease transmission, contain outbreaks, and alert the public and providers of disease risks.

Healthy CommunitiesThis is an integrated team of healthy communities specialists and a health educator focused on prevention of injuries and chronic diseases. Their work is focused on changing policies, community systems, and environments in the areas of opioid use, youth marijuana use, tobacco/vaping, suicide prevention, vaccine-preventable diseases, and healthy eating and active living.

HIV/STDHIV/STD prevention services include case and contact investigations, STD testing, and client vouchers for community provider testing and treatment.

Maternal-Child HealthThis program provides services to families in promotion of healthy parenting outcomes, mitigates adverse childhood experiences, and trains providers on universal developmental screening. It’s funded with a Washington State Maternal-Child Health block grant and Medicaid Administrative Claiming funds.

Perinatal Hepatitis BThis program conducts activities to prevent perinatal hepatitis B infection in newborns and case management of infants born to hepatitis B-positive mothers.

Population-Based Parent Child HealthBuilding on community partnerships, staff work with programs that support healthy parenting. This program is focused on population results rather than one-on-one services.

Division Budgets


Division Budgets

Public Health Emergency Preparedness Response (PHEPR)The PHEPR program is responsible for helping public health in Snohomish County and the four counties in Region 1 (Skagit, Whatcom, San Juan, and Island) prepare for and respond to public health emergencies, including disease outbreaks, storms, earthquakes, and other natural or manmade disasters. Staff maintains agency response plans, provides training and exercises to test the plans, and supports communications for public health and other healthcare partners throughout the region. Disease surveillance and response is a critical component of the PHEPR program and the District’s ability to protect the public from communicable diseases. The District also coordinates the local Medical Reserve Corps, a volunteer organization with surge capacity during an emergency.

Refugee HealthThis program offers a comprehensive health screening and referral to primary and specialty care for refugees. Care is initiated within 90 days of arrival in the U.S. This program is funded through the Department of Social and Health Services.

Tuberculosis Control and EliminationThis program focuses on prompt evaluation, treatment, and case management of active TB cases. Staff perform contact investigations of individuals exposed to tuberculosis. It is mandated by WAC 247.170.

Vaccine Preventable DiseasesChildhood immunizations are promoted through community and provider education and outreach in Snohomish County and other counties in Region 1 (Skagit, Whatcom, Island, San Juan). Activities are partially funded by a Washington State Department of Health contract.

Viral Hepatitis OutreachThis program provides targeted counseling, testing, education, and referrals to people who have used or currently use injection drugs. Grant funds are used to focus on testing individuals in the jail setting.


PREVENTION SERVICES DIVISION

Division Budgets

Prevention Services

Revenue:Licenses & Permits $0Federal Grants 2,591,967State Grants 685,668Intergovernmental Revenue 1,500,000Charges for Goods & Services 327,961Miscellaneous Revenues 0 Total Revenues before Reorganization 5,105,596


Non-Labor:Supplies ($153,672)Professional Services (352,396)Communication (30,777)Mileage & Travel (12,851)Board of Health Per Diem 0Advertising (15,367)Rents & Leases (12,124)General Insurance 0Utilities 0Repairs & Maintenance (16,800)Other Miscellaneous (13,390)Dues & Memberships (950)Subscriptions (840)Printing & Binding (1,264)Tuition & Registration (16,540)Software Licences & Support (232,498)Software Licences & Support - Board 0Capital 0Subtotal - Non-Labor ($859,469) Total Expenditures before Reorganization ($5,648,941)

Net Revenue ($543,345)



The item below represents estimated costs associated with upgrading and replacing information technology equipment. The Health District anticipates large remodeling expenses in 2021, but does not have estimates from the architectural team. Those planning efforts will be brought back to the Board for review and approval.

Capital Request

QuantityUnit Cost

Extended Cost

IT Switches, Servers 1 $70,000 $70,000

Grand Total $70,000

2020 Capital Budget Request


As the District looks toward a more sustainable future, it needs to invest in both its headquarters and organizational capacity. The items below represent estimated costs for much-needed operations and maintenance work for the Rucker Building. Implementing a new electronic health record system is a critical need for data infrastructure reliability and client tracking.

Non-Capital Request

2021 Non-Capital RequestsLarge Repairs & Maintenance Projects

Replace Carpet - Suites 104, 200, 203, 204, 208 $56,125Window Replacement 47,726Other Deferred Building Maintenance 50,137

Subtotal - Large Repairs & Maintenance Projects $153,988

Records Digitization Project 200,000EHR Implementation 150,000Total Non-Capital Requests $503,988


To be included in final budget.

Policy Discussions


Appendices

To be added in final budget document.


SNOHOMISH HEALTH DISTRICT3020 Rucker Ave, Suite 306Everett, WA 98201

2021 preliminary budget - snohd.org

Documents